Head and Cervical Posture in Sagittal Skeletal Malocclusions: Insights from a Systematic Review

Background: This systematic review aims to evaluate the relationship between craniocervical posture and sagittal skeletal malocclusions, focusing on cervical curvature, head posture, and the influence of skeletal classification on craniofacial development. Methods: A comprehensive electronic search was conducted across PubMed, Scopus, and Web of Science for studies published between January 2015 and January 2025. Studies meeting the PICOS criteria, which assessed craniocervical posture in individuals with skeletal Class I, II, or III malocclusions, were included. A total of 12 studies were reviewed and analyzed for relevant data. Results: Significant correlations were identified between sagittal skeletal malocclusions and craniocervical posture, particularly cervical curvature. Class II malocclusion was associated with increased cervical curvature and forward head posture, whereas Class III malocclusion was linked to straighter cervical columns and a more posterior head position. Variations in cervical vertebral morphology were also observed, especially in relation to head posture and craniofacial structure. However, considerable heterogeneity was noted among studies regarding sample populations, measurement techniques, and classification criteria. Conclusions: This review highlights a strong interrelationship between craniocervical posture and sagittal skeletal classification, with potential clinical implications for orthodontic diagnosis and treatment planning. Further longitudinal studies are needed to establish causal relationships and improve orthodontic management strategies.